Abstract
Anal pressure vectography is an attractive study which can provide colourful 3-dimensional video images to assess radial asymmetry. However, the value of this test is still uncertain. The aim of this study was to assess prospectively the correlation among APV and other anorectal physiological tests, such as anal manometry, anal sphincter electromyography (EMG), and anal ultrasonography. Fifty consecutive patients with faecal incontinence were evaluated. All 50 patients had APV and anal manometry during the same visit. APV revealed mean maximal resting and mean maximal squeeze pressures of 83.1±28.4 mmHg and 106.3±34.5 mmHg, respectively. Anal manometry showed mean maximal resting and mean maximal squeeze pressures of 55.9±19.4 mmHg and 57.7±29.4 mmHg, respectively. The difference between APV and manometry for both mean maximal resting and mean maximal squeeze pressures were significant (P<0.05). Thirty-four of the 50 patients (68%) showed global defects of the sphincters on cross-sectional vectogram. Forty-six patients also had anal sphincter mapping with electromyography; 38 patients had isolated decreased EMG activity in a single quadrant. However, only five of the 38 patients (13.2%) had the same defect localized by APV. Lastly, 33 patients had anal ultrasonography; 27 patients had anal sphincter defects. However, only 3 of the 27 patients (11.1%) had the same defects localized by APV. In conclusion, APV had poor correlation with other anorectal physiological tests, including anal manometry, anal sphincter EMG, and anal ultrasonography. Therefore, APV has no apparent advantages, so its use cannot be supported.
Résumé
La vectographie de la pression anale est une méthode d'étude très attractive qui fournit des images vidéo en couleurs de trois dimensions permenttant de mettre en évidence des asymétries radiales. La valeur d'un tel test est toutefois incertaine. Le but de cette étude est de déterminer prospectivement la corrélation entre la vectographie et d'autres techniques d'investigations physiologiques anorectales telles la manométrie, l'électromyographie sphinctérienne et l'ultrasonographie. Cinquante patients consécutifs avec incontinence fécale ont été évalués. Les cinquante patients ont subi au cours d'une même séance une vectographie et une manométrie anale. La vectographie a mis en évidence une pression maximale moyenne de repos et une pression maximale moyenne de contraction de 83,1±28,4 mmHg et 106,3±34,5 mmHg. La manométrie anale a montré une pression maximale moyenne de repos et une pression 57,7±29,4 mmHg. Les différences mesurées entre vectographie et manométrie sont statistiquement significatives à la fois pour la pression moyenne de repos et pour la pression moyenne maximale de contraction (P<0,05). Trente quatre des 50 patients (68%) présentent des défects globaux des sphincters sur les sections transverses du vectogramme. Quarante six patients ont également subi une cartographie électromyographique; 38 présentent une diminution d'activité à l'EMG dans un seul quadrant. Seuls 5 des 38 patients (13,2%) présentent un défect de même localisation à la vectographie. Finalement 33 patients ont subi une ultrasonographie; 27 sont porteurs de défects sphinctériens. Seuls 3 des 27 patients (11,1%) ont un défect de même siège que celui identifié à la vectographie. En conclusion, la vectographie n'a qu'une faible corrélation avec les autres techniques d'investigations physiologiques ano-rectales incluant la manométrie, l'électromyographie sphinctérienne et l'ultrasonographie. La vectographie n'a aucum avantage apparent et son emploi ne doit pas être recommandé.
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Dr. Yaong is a visiting surgeon fromthe Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
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Yang, Y.K., Wexner, S.D. Anal pressure vectography is of no apparent benefit for sphincter evaluation. Int J Colorect Dis 9, 92–95 (1994). https://doi.org/10.1007/BF00699420
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DOI: https://doi.org/10.1007/BF00699420